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Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents

Tables

Table 1. Prophylaxis to Prevent First Episode of Opportunistic Disease

For individuals exposed to a sex partner with a diagnosis of primary, secondary, or early latent syphilis within past 90 days (AII), or

For individuals exposed to a sex partner >90 days before syphilis diagnosis in the partner, if serologic test results are not available immediately and the opportunity for follow-up is uncertain (AIII)

CD4 count ≤150 cells/µL and at high risk because of occupational exposure or live in a community with a hyperendemic rate of histoplasmosis (>10 cases/100 patient-years) (BI)

Itraconazole 200 mg PO daily (BI)

Coccidioidomycosis

A new positive IgM or IgG serologic test in patients who live in a disease-endemic area and with CD4 count <250 cells/µL (BIII)

Fluconazole 400 mg PO daily (BIII)

Varicella-zoster virus (VZV) infection

Pre-exposure prevention:
Patients with CD4 counts ≥200 cells/µL who have not been vaccinated, have no history of varicella or herpes zoster, or who are seronegative for VZV (CIII)Note: Routine VZV serologic testing in HIV-infected adults and adolescents is not recommended.Post-exposure prevention: (AIII)
Close contact with a person with chickenpox or herpes zoster; and is susceptible (i.e., no history of vaccination or of either condition, or known to be VZV seronegative)

Patients without chronic HBV or without immunity to HBV (i.e., anti-HBs <10 international units/mL) (AII)

Patients with isolated anti-HBc and negative HBV DNA (BII)

Early vaccination is recommended before CD4 count falls below 350 cells/µL (AII). However, in patients with low CD4 cell counts, vaccination should not be deferred until CD4 count reaches >350 cells/µL, because some patients with CD4 counts <200 cells/µL do respond to vaccination (AII).

In general, patients should be vaccinated, regardless of CD4 cell counts (CIII).

Anti-HBs should be obtained 1 month after completion of the vaccine series. Patients with anti-HBs <10 international units/mL at 1 month are considered non-responders. (BIII).

Some experts recommend vaccinating with 40-µg doses of either HBV vaccine (CIII).

Vaccine Non-Responders:

Anti-HBs <10 international units/mL 1 month after vaccination series

For patients with low CD4 counts at time of first vaccine series, some specialists might delay re-vaccination until after sustained increase in CD4 count with ART (CIII).

Re-vaccinate with a second vaccine series (BIII)

Some experts recommend re-vaccinating with 40 µg doses of either HBV vaccine (CIII).

Malaria

Travel to disease-endemic area

Recommendations are the same for HIV-infected and HIV-uninfected patients. Recommendations are based on region of travel, malaria risks, and drug susceptibility in the region. Refer to the following website for the most recent recommendations based on region and drug susceptibility: http://www.cdc.gov/malaria/.

Penicilliosis

Patients with CD4 cell counts <100 cells/µL who live or stay for a long period in rural areas in northern Thailand, Vietnam, or Southern China (BI)

Evidence Rating:
Strength of Recommendation:
A: Strong recommendation for the statement
B: Moderate recommendation for the statement
C: Optional recommendation for the statement

Quality of Evidence for the Recommendation:
I: One or more randomized trials with clinical outcomes and/or validated laboratory endpoints
II: One or more well-designed, nonrandomized trials or observational cohort studies with long-term clinical outcomes
III: Expert opinion

In cases where there are no data for the prevention or treatment of an OI based on studies conducted in HIV-infected populations, but data derived from HIV-uninfected patients exist that can plausibly guide management decisions for patients with HIV/AIDS, the data will be rated as III but will be assigned recommendations of A, B, C depending on the strength of recommendation.How to Cite the Guidelines